初次人工髋关节置换术后假体脱位原因分析及预防

目的探讨初次人工髋关节置换术后假体脱位的原因并提出预防措施。方法回顾分析2000年-2012年所完成221例人工髋关节置换患者及发生术后脱位的8例患者资料，总结脱位原因及所采取的预防措施。结果221例髋关节置换患者中，发生术后脱位8例，均为后外侧人路全髋关节置换患者，脱位原因包括术前并存肌力减退疾病、术中假体安置不当、术后不适当的体位改变及护理、宣教不到位等。8例脱位患者中2例行再次手术翻修后治愈，6例通过麻醉下行闭合复位治愈；7例随访1～5年，未再发生脱位。结论术前认真评估患者患髋软组织张力及合并疾病情况，选择设计合理的假体及组件，术中清除可能引起关节撞击的组织，正确放置人工关节假体及组件，术后指导患者正确的患髋活动方式对预防术后关节脱位都至关重要。

Analysis and Prevention of Prosthesis Dislocation after Primary Artificial Hip Replacement

Objective To explore the cause of prosthesis dislocation after primary artificial hip replacement （AHR） and propose preventive measures. Methods A total of 221 patients underwent artificial hip replacement from 2000 to 2012, among whom 8 developed dislocation. These cases were retrospectively analyzed to summarize the causes of dislocation and preventive measures were proposed. Results Among 221 cases of hip replacement, 8 suffered from postoperative dislocation. All of them underwent posterolateral-approach total hip arthroplasty. The causes of dislocation included coexisting decreased muscle strength before operation, improper placement of the prosthesis during operation, inappropriate postural changes after operation, improper nursing and health education. Of the 8 dislocation cases, 2 were cured after reoperation and revision, 6 were cured through close reduction under anesthesia, and 7 were followed up for 1-5 years without relapse. Conclusion Preoperative assessment of the patients＇ soft tissue tension of affected hip and comorbid conditions, selection of proper design of prostheses and the components, removal of tissues possibly causing joint impact, correct placement of artificial prosthesis and components and instructing the patients for the correct movement mode of the affected hip after operation are all crucial for the prevention of postoperative hip dislocation.